At 37, Samantha Murrell was the epitome of health. She hiked daily and enjoyed other outdoor activities such as paddleboarding and mountain biking near her home in Montana.
Murrell also proactively took care of her health and stayed current with preventative care checkups. She diligently looked for moles that might indicate the onset of skin cancer, performed breast self-exams because of a family history of breast cancer, and kept appointments with gynecologists to detect early signs of reproductive cancer.
In early 2024, Murrell took a trip to India and struggled with a mild cough and chest pressure upon her return. Although she went about her daily activities, after two weeks the pressure on her chest became uncomfortable and she went to an emergency room for treatment.
An X-ray showed her left lung had collapsed and was full of fluid. She was told to go to the emergency room immediately. After the fluid was drained and tested during her hospital stay, the result came back as stage 4 lung cancer.
“I was so surprised when they said I had lung cancer,” Murrell said. “This was the most confusing thing because I had never been informed that non-smokers could get lung cancer. If I had been told I had breast cancer, cervical cancer, or skin cancer, I probably would have accepted it right away and said, “Okay, let’s do this,” but I thought that was the only cancer I just couldn’t get could because I did it. “I don’t smoke.”
Read: Women who have never smoked can get lung cancer >>
What causes lung cancer in non-smokers?
While smoking remains the leading risk factor for lung cancer, diagnoses like Murrell’s are becoming more common among non-smokers. Up to 2 in 10 lung cancers (20,000-40,000 per year) are diagnosed in people who have never smoked or smoked fewer than 100 cigarettes in their lives. Lung cancer is also more common in people over 65, with the average age of diagnosis being 70. However, younger women are now more likely to be diagnosed with lung cancer than their male counterparts – especially non-smokers.
Norman Edelman, MD, a professor of medicine at Stony Brook University who studies lung disease, said there are no clear answers as to why lung cancer rates are increasing among nonsmokers, but those exposed to particulate pollution are at the highest risk .
“Environmental pollutants likely increase the risk of lung cancer as much as cigarettes do, because oxidizing chemicals destroy the DNA of cells,” Edelman said. “Although research is limited to pollutants that are monitored, fine particles are the most studied and most affected.”
While secondhand smoke – exposure to other people’s smoking – can be a factor in the development of lung cancer, environmental factors such as radon, air pollution, wildfire smoke and particulate matter are increasingly linked to cases in non-smokers. According to the Environmental Protection Agency, radon — radioactive gas that enters homes — is the leading cause of lung cancer in nonsmokers and contributes to about 2,900 lung cancer deaths in nonsmokers each year.
Further research also links genetic factors to the development of lung cancer. Studies show how air pollution triggers the development of lung cancer in cells with certain genetic mutations. While Murrell’s short trip to India likely did not lead to lung cancer, she believes the change in air quality and a weakened immune system from the trip triggered the symptoms that led to her diagnosis.
Continued research into genetic mutations could provide more insight into the links between pollution and lung cancer in non-smokers. Murrell said she has the HER2 mutation, which is most common in people with breast cancer, although up to 2% of lung cancer patients have the HER2 mutation. More common cell mutations in lung cancer patients are ALK or EGFR.
Read: Understanding the different types of lung cancer >>
When Murrell was in the hospital for her initial treatment, she tried to figure out the cause of her cancer. She remembers filling out a questionnaire asking if she had worked in a factory or lived in an area with high levels of pollution or coal mining – none of which were true. She lived in Iowa for seven years and read that Iowa had the fastest growing rate of new cancers in the United States. Could she have been exposed to agricultural pollutants years ago?
“I don’t have a concrete answer to my case,” Murrell said. “I was never around secondhand smoke. I didn’t have a dangerous job. I don’t think I’ve been exposed to radon as I’ve moved around a lot and have only lived in the same house for about two years my entire life. I just don’t know.”
Reduce your risk of lung cancer
While anyone can get lung cancer, people with dark skin — especially women — have worse outcomes from the disease, often because they are less likely to receive an early diagnosis or treatment, according to the American Lung Association. This is the case even if they experience common lung cancer symptoms such as increasing cough, chest pain, shortness of breath, wheezing, coughing up blood, and fatigue.
Murrell recommends anyone experiencing these symptoms seek immediate medical attention, although she is aware of several survivors who have been misdiagnosed for years. When they received the diagnosis, they were in stage four.
“If you have these symptoms and they don’t go away with normal treatments, be really persistent and push for further evaluation,” she said.
Read: Doctors shook off my cough because I wasn’t a smoker – but I had stage 4 lung cancer >>
Edelman also encourages those who are eligible to get a lung cancer screening. “The CAT scan screening was successful. “Over the last few decades, the five-year survival rate for lung cancer has increased,” he said.
To be eligible for an annual exam under current U.S. Preventive Services Task Force guidelines, you must be between 50 and 80 years old, currently smoke or have quit smoking within the last 15 years, and have a smoking history of 20 packs per year have. (One pack-year is equivalent to smoking one pack [20 cigarettes] one day, every day for a year. A person could have a history of smoking 20 packs per year if they smoked one pack per day for 20 years or two packs per day for 10 years. However, these criteria can result in many people without risk factors being excluded.
Murrell knows of younger women with a family history of being rejected for screening, and she points out that she didn’t have any of the typical lung cancer symptoms that would have led a provider to suggest screening. The only early sign she recognizes now was a blood clot in 2023 that medical professionals said could be related to contraceptive use or prolonged sitting on another plane trip. She now believes the clot was likely an early sign of lung cancer.
Today, Murrell and her husband live in Park City, Utah, where she can be closer to an NCI-designated cancer center for treatment. Despite her diagnosis, she describes her life as “pretty normal,” still hiking four miles a day, lifting weights and working full time. She attributes her good health to her lifestyle before her cancer treatment and is grateful that she can continue doing the things she enjoys.
She is also involved with the Young Lung Cancer Initiative, which she found to be a source of support during her treatment. On her website and social media, she read several stories of people doing well years after a stage 4 diagnosis.
“The Young Lung Cancer Initiative really caught my eye,” she said. “After my diagnosis at my local hospital, I initially had nine months to live, but seeing people’s messages gave me great hope for this journey. I’m so happy I found the group so early.”
This educational resource was created with the support of Daiichi Sankyo.
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